Intactivism News

October - December 2008

Injured in/by their belief

By Adelheid Müller-Lissner

Ritual cutting of the male foreskin has a tradition of over 3000
years. Both Jews and Muslims refer to God's command to their forefather Abraham
that "everyone who is male among you shall be cut". Genital cutting of boys,
medically termed circumcision [Zirkumzision" more commonly "Beschneidung" - cutting], can't be compared to female genital mutilation, which has much more grave consequences. Nevertheless, it has become a topic for discussion in Germany and especiallyly in Denmark, among politicians, physicians and lawyers who want it to be prevented or forbidden.

The Berlin-based Jewish newspaper "Jüdische Allgemeine" reports that
attacks on ritual circumcision are met with unanimous indignation among
the representatives of Jewish communities in Germany. "Circumcision of our
male descendants has been an inseparable component of our faith for 3400
years," Julian Chaim Soussan, the community rabbi of Düsseldorf, explains
on behalf of the Conference of Orthodox Rabbis in Germany. The Jewish
"Brit Mila", as the rite is called, traditionally takes place before [on] the
eighth day of life. If that were made impossible in Denmark, a kind of
circumcision tourism would be the result, Soussan fears. "We're shocked
that just six decades after the Shoah [Holocaust], Jews living in a Western European state are forced to seriously consider leaving their home country to be
able to practice Judaism freely."

In the Jewish tradition, the mohel is responsible for ritual
circumcision. In the German physicians' journal "Deutsches Ärzteblatt"
however, two professors of medicine and one professor of law discuss how
physicians should react when parents approach them wanting
circumcision for religious reasons. In the eyes of the scientists, it is a
real dilemma: On the one hand, the parents have custody of their child,
including concerning religious issues. "On the other hand, the physician is
asked to perform surgery without medical necessity." Surgery which, in the
opinion of the authors, could strictly speaking be classified as bodily
injury, and, just like any other surgery, is not free of risks and side-effects. Paediatric surgeons Maximilian Stehr and Hans-Georg Dietz of the Dr. von Hauner'schem Children's Hospital of the University of Munich and criminal law specialist Holm Putzke of the University of Bochum
are therefore unequivocal: "As long as the legal situation is not
clarified, physicians should refuse to perform non-medically-indicated
circumcisions." However, circumcision can be medically necessary if the
foreskin of the penis is so tight that urination is difficult or
infections develop repeatedly under the foreskin. But in simple cases,
surgery is often not necessary; ointments containing cortisone can help,
too. Many parents, who want circumcision of their son for religious
reasons, use tightness of the foreskin and problems as an excuse, in order
to have the surgery paid by their health insurance, the Munich paediatricians complain.

The debate is confusing: For many years, medical arguments have been put
forward for removing the foreskin even when no disease is present. Most
recently, the World Health Organization (WHO) made a recommendation
regarding preventive circumcision, after a study had come to the
conclusion that the [HIV/AIDS] infection risk in Africa could be lowered by
circumcising. But circumcision provides no reliable protection - and in most
countries, expenses and benefits would be drastically mismatched. Penile
cancer is too rare, too, for it to be a valid argument for circumcision.
In the USA, where just ten years ago six out of ten boys were circumcised
shortly after birth by physicians, because it was thought to be good
prophylaxis, the numbers have fallen significantly, since the relevant
medical society does no longer recommend circumcision as a routine
measure.

And so remains, apart from clearly defined medical indications, the
religiously motivated circumcision of Jewish and Muslim boys.

Yadollah Moazami-Goudarzi, a paediatric surgeon practicing in Berlin, sees his
role as a physician not least as an educator: "When parents with this
wish come into my practice, I try to make it clear to them that
circumcision also has disadvantages and that today's children grow up in a
changed society, under different hygienic and climatic conditions than the
religion's founders." In case of doubt, he pleads for a "sparing
circumcision", a plastic widening, as it is [commonly, but by no means universally] done in the surgery for
phimosis. "But only a surgeon is qualified to do that." The young patients that Frank Christoph, urologist
at the Charité in Berlin, sees during the paediatric-urological
consultation at the Otto-Heubner-Zentrum on the Campus Virchow, almost
exclusively need the surgery because of tightness of the foreskin. They
usually come in between the second and tenth year of life. "We are only
rarely confronted with a request for circumcision for ritual reasons." So
far, it has also been rare for a child to be admitted to the hospital with
a serious complication after circumcision. "The ritual circumcisers
obviously have expertise acquired by tradition and many years of
experience." Thus, medical objections to circumcision are rather
unfounded [if you leave out human rights].

But members of the religious communities have objections, too. Nobody
should "ever take a knife to a baby's flesh in the name of religion", the
Jewish doctor and psychotherapist Jenny Goodman wrote as far back as ten
years ago. The circumcision opponent from Britain refers to a quote from
the Bible, too. After all, God admonished Abraham: "Lay not thy hand upon
the boy, neither do anything to him."

The question remains whether actually "something is done" to the boy by
circumcising him. [Silly question! Of course it is!] Maybe it is a question of belief after all.

Parents refuse to take initiates to doctors

PARENTS in the Pondoland area are refusing medical care to children suffering from botched circumcisions because, they say, it undermines the tradition.

This revelation from the provincial Health Department comes as the death toll in the December initiation season climbs to 10 in the Eastern Cape, double the figure at the same time last year.

Most of the reported circumcision deaths have taken place in Maluti, where three initiates have died. One of the victims, however, is reported to have drowned.

Health spokesperson Sizwe Kupelo yesterday said the boy drowned in a river last weekend while undergoing the traditional bath ahead of his graduation. Kupelo warned those who attended to initiates to first make sure that the rivers they used were safe and shallow.

Despite the latest round of fatalities, traditional leaders have defended the rite and blamed parents for problems arising from the practice. Nkosi Ngangomhlaba Matanzima, Eastern Cape House of Traditional Leaders’ chairperson, yesterday said parents were at fault for complications experienced by their children during circumcision.

“The problem is that parents don’t care and the children are also ill- disciplined,” said Matanzima.

He said parents needed to prepare their children before they went to initiation schools, and educate them on the rite.

“These boys need to be armed with information from their parents about the implications of going to initiation school. They need to know what not to do while they undergo the rite,” Matanzima said.

He said boys also needed to be disciplined while they were at initiation schools. Matanzima called on parents, health officials and traditional leaders to find solutions to the problem.

“If nothing is done, children will continue to die in shame,” Matanzima said.

This included parents taking their children for medical attention if they needed it.

He was responding to claims by Kupelo that parents were withholding medical care because it meant their sons weren’t “man enough” for initiation.

Meanwhile Kupelo said at the start of the initiation season, 30 initiates had been admitted to Mthatha General Hospital for complications related to their circumcisions. At least 17 are still at the hospital.

There are another 12 at the Nelson Mandela Academic Hospital, where two are in a critical condition.

“We are, however, doing everything we can to work with all the stakeholders to save more lives and we urge all those affected to co- operate with us,” Kupelo said.

Man found dead near Nicholls campus

John DeSantis
City Editor

THIBODAUX -— A 48-year-old man found dead of what police say was a self-inflicted gunshot wound was facing criminal charges for allegedly threatening to blow up a local hospital over a dispute stemming from a circumcision he underwent several years earlier.

The body of Beasley Allen Terrebonne was found about 12;30 p.m. Tuesday by a maintenance worker near a grove of trees where Thibodaux Regional Medical Center and Nicholls State University meet.

Investigators said a note and information from relatives brought them to the conclusion that Terrebonne had taken his own life, presumably about two hours before his body was found.

...
Terrebonne’s story, according to relatives and officials alike, was a tragic tale of a man overwhelmed by bureaucracy and personal emotional pain.

He was arrested Oct. 22 after allegedly threatening to blow up Ochsner St. Anne General Hospital in Mathews because, police were told, the hospital allegedly botched a circumcision performed on Terrebonne three years ago.

State Sen. Reggie Dupre, D-Bourg, said Terrebonne spoke with his assistant after calling Dupre’s Houma office. Terrebonne said he wanted to sue the hospital but he couldn’t find a lawyer to represent him, Dupre said.

Under state law, claims for alleged malpractice must be made within a year of the event. No lawsuit, to anyone’s knowledge, had ever been filed against doctors or the hospital.
...

One of the problems that dogged Terrebonne, officials said, was the bills he got from the hospital. That appeared to inflame his anger over his claim that the medical procedure had gone awry.

...
Ochsner St. Anne administrator Milton Bourgeois said ... “all levels of the Ochsner system” were involved in trying to aid Terrebonne with his grievance, but that once the threat was made those attempts ceased.

Sylvia Terrebonne, the dead man’s sister-in-law, said Wednesday that Terrebonne was not violent, and that she did not believe he would ever harm anyone.

Washington, Dec 21 (ANI): Circumcision significantly reduces the risk of HIV infection in heterosexual men, says a new U.S. study. [No, only in a small subset.]

The findings complement those of recently reported clinical trials in Africa, where interventional use of adult male circumcision similarly reduced the risk of HIV infection in heterosexual men.

The study has been published in the January 1 issue of The Journal of Infectious Diseases.

Lee Warner, PhD, MPH, and colleagues at the Centers for Disease Control and Prevention (CDC) and the Johns Hopkins University School of Medicine studied the records of more than 26,000 African American men who had had HIV testing during visits to two Baltimore, Maryland, STD clinics from 1993 to 2000.

The subjects selected for the study said that they did not inject drugs and had sex only with women. Their visits to the clinics were classified as involving known HIV exposure if there had been a recent notification of such exposure by a sex partner or by a clinic's disease intervention specialists; clinic visits for other reasons were classified as involving unknown HIV exposure.

By these criteria, the investigators found 394 visits [by 385 men, only 50 of them intact] with known exposure and 40,177 visits with unknown exposure. In visits by men with known HIV exposure, being circumcised was associated with a 51 percent reduction in HIV prevalence (10.2 percent of circumcised men [38 men] vs. 22.0 percent of uncircumcised men [11 men. Circumcising the whole cohort of 26,400 babies might have reduced that to 10%, or five men, i.e. it might have prevented six infections.]).

["Known' vs "unknown" are semi-artifical constructs: "unknown" does not mean "none" - 2.7%, 1096 men, were infected - and the possibility arises that the parameters of "known" risk were adjusted to make the results conform to a predetermined conclusion.]

There are 175,000 people in this catchments area. 45% have AIDS. Forty five percent. There are two brand new medical cenJeremy's Journal from Africa
ters in the village. No one works from there, they are empty shells. The medical equipment lies unused, but the organization that provided them can proudly proclaim success. They are unused because no doctor or clinician will work there, it is too rural. There are no counselors for education, because they are too expensive to train.
When AIDS started spreading, no one knew what it was. They blamed it on Juju, a spell cast by the nasty neighbors. When they called the mganga, the traditional healer, to cure the disease they used scarification, a technique of making small cuts in the skin and putting herbal medicine in. They do this with dirty unsterelised knives. Result- immediate infection with AIDS. In my clinic in Dar es Salaam, a patient told me how this happened to her. Not every infection is through sex.

This is coffee country. The western demand for organic coffee accelerated the spread of AIDS. They uprooted all the non organic crops, and there was no work. The locals, who belong to the intelligent Chaga tribe, traveled far and wide looking for work. And when they are away, they sleep with prostitutes. Frequently. Then they come home for Christmas, and the party begins. For two weeks everyone is drunk, and promiscuity abounds.

Meanwhile, those who stay to work the coffee plantations get paid on a daily basis. They bring the money home and drink the very potent home brew. More promiscuity, and the next day, no money for food.

...
Steve, and many others, tried to explain about condoms. The locals took it as a sign that there was a conspiracy to limit their population and refused to use them. The Chinese government sent over a ship load of condoms to Africa. They were two sizes too small at best, so all those who tried them never tried again.

Some research showed that circumcised men got infected less. Who knows by how many statistically significant percent. So many were told it was a good idea to be circumcised. Those who bought the promise and got a circumcision believed it would give them full immunity. They got infected. In Kenya, Steve's tribe was told they had to all get circumcised. They refused. Someone on TV asked where all the nurses will come for that amount of circumcising. There was no answer.

No one wanted to be tested for AIDS. Too much taboo and stigma involved. To get around this, a proposal came up to disguise the Testing centers as cyber cafes. In other words, you go to a cyber café and willingly or not, you get tested. Needless to say, that idea died.

A particular Christian denomination called "Assembly of God" that is popular in the region, preached that it is a sin to take the medication, because God will save you. If you have ' the disease' you are a sinner, but seeing God will save you, you are absolved. Then you die.

ARVs are difficult to get, the distance to town is too great. The mothers walk 15 km to town with one bunch of bananas on their head and sell them for $2, and because it is night when they finish, they have to get back by bus, which costs 50 cents. There is no time to collect ARVs. So along came a well meaning organization and gave money for the people to ride into town for ARVs. For one month. The poor souls that were unfortunate enough to participate in this scheme died very soon after the month was over. These drugs are not meant to be taken for a month. This is a long term disease. These drugs are not meant for the malnourished, for those who can't afford them, for those who can't access them.

...
It reminds me of when I met Wilfred in the computer shop earlier today, and told him of the project. He said; 'AIDS is big business in Africa, don't mess with it'

Steve knows nothing about homoeopathy, except the little he heard from our friend Caragh. His first question was, is it herbalism. When he was assured it was not, he was satisfied. More than that, he was eager. He went out and spoke to the chiefs this weekend. The people there didn't ask questions. They didn't want to know if we were medically qualified. They didn't care where we came from, or what diplomas we had, or about research, or scientific proof. They just asked for us to come. And before they met us, they set aside a room in the health center. I was happy, mixed with fear and trepidation. Steve said that they were happier.

[So the people are set up to be let down again. There is no evidence that homeopathy is efficacious against HIV/AIDS.]

Pierced kittens removed from home

They were pierced in tail, neck and ear and were to be sold, officials say.

By Edward Lewis elewis@timesleader.com
Staff Writer

ROSS TWP. – Three kittens with ear, neck and tail piercings were removed from a home by humane officers on Wednesday.

One of the officers from the Society for the Prevention of Cruelty to Animals of Luzerne County said the pierced kittens were being sold as “gothic kittens” on an Internet auction site.

“This is a first,” said Officer Carol Morrison. “It’s unbelievable anybody would do this to kittens.”

Morrison said the investigation began about a week ago when a man from another state noticed “gothic kittens” being sold on eBay. The kittens were also being sold on a pet classified Web site with an attached picture of a pierced kitten.

...

The man called the phone number that was listed with the kittens, and traveled to the home at 71 Dobson Road, where he saw the pierced kittens, Morrison said.

“He called us and explained what he saw,” Morrison said.

...

“She (the homeowner) thought it was a great idea (to pierce kittens),” Morrison said.

Morrison said charges are likely to be filed against the homeowner.

A dog inside the home was also found with pierced ears, Morrison said.

Morrison said the homeowner has a pet grooming business in the basement of the residence. ...

The kittens also had submission rings placed in their tails, Morrison said, explaining that the rings would prevent blood flow, causing the tails to fall off. ...

Morrison said the kittens will be checked by a veterinarian before deciding if the kittens will be placed for adoption.

Take It or Leave It

OPINIONS & COMMENTARIES
Austin Ejiet

HIV/ Aids: Parliament’s final solution
As the year 2008 winds down to an end, certain highlights will inevitably stand out, not least among them the election to the U.S. presidency of the first African - American candidate,...

This country has lost its pre-eminent position as the one place that successfully fought HIV/Aids, bringing the national rates of infection from a mind blowing 25 or even 30 per cent of the population to about 6 per cent or less. Why we have lost our position as the show-case for combating the epidemic remains a matter for conjecture.

Some people blame the rising rates of infection on fatigue , that is to say on the possibility that after waiting for 30 years for the virus to go away, men and women may have decided to return to business as usual in the oft stated belief that sweets are never eaten with their wrapping or bananas with the thick yellow skin. Other analysts have blamed the rising rates of infection on a tragic misconception that the Anti Retroviral drugs (ARVs) are in fact a cure.

The other possible explanation that is never discussed openly is that certain Aids programmes prevailed on our leaders to ditch the condom and emphasise only fidelity and abstinence. We have also been told that male circumcision will reduce the chances of getting infected by as much as 60 per cent , even though every fool can see that the epidemic is highest in certain communities where male circumcision is [] universally practiced as a rite of passage to manhood.
...

In Osun, controversy trails move by House of Assembly to outlaw tribal marks, circumcision

By Tunde Odesola

When did it become an offence for parents to circumcise their children? That is the question many parents in Osun State may soon be asking law enforcement agents if the state government put teeth into the Child Rights Act recently passed by the House of Assembly. Under the law, no parent or guardian has the right to “tattoo or make a skin mark on a child. A person who tattoos or makes a skin mark on a child commits an offence under this Law and is liable on conviction to a fine not exceeding five thousand naira or imprisonment for a term not exceeding one month or to both such fine and imprisonment.”

Skin mark, in the eye of this law, means any form of genital mutilation or facial mark. But religion appears the biggest challenge of this law.

Logic and the rights of the child appear to play little part in determining the acceptability of genital mutilation in our society. Article 24(3) of the United Nations convention on the rights of the child commits all ratifying states to taking all effective and appropriate measures with a view to abolishing traditional practices prejudicial to the health of children.” And article 19(1) says, “States shall take all appropriate legislative administrative social and educational measures to protect the child from all forms of physical or mental violence, injury or abuse.”

Anti-circumcision exponents, Y Hofvander and J Smith, in their respective works against circumcision, contend that it cannot be in the best interest of a child to be subjected, without its consent, to an irreversible surgical procedure, often without anesthetic.

In the US and UK, female genital mutilation is expressively barred by law but the same cannot be said of male circumcision which is approved if the two parents consent on religious or cultural grounds.

Among some ethnic groups, an individual receives his or her first marks at the age of 14, signifying transition from childhood to adulthood.

Commenting on circumcision and facial marks for children, the Ooni of Ife, Oba Okunade Sijuwade, threw his weight behind the abolition of the age-long practice, saying it has outlived its usefulness. The traditional ruler of Ile-Ife, which is widely held as the cradle of the Yoruba traditional and cultural practices, held that practices that were harmful or capable of inflicting pain on people should be expunged.

...

But world acclaimed Ifa priest and Awise of Osogbo, Chief Yemi Elebuibon, disagrees with the opponents of circumcision and facial marks. He said, “Tattoo is a form of identification and beautification practised by Europeans, Australians and Americans. It is unfortunate that western values have continued to erode our tradition and culture. It smacks of inferiority complex to canvass abolition of facial marks or circumcision. What government should do is ensure the use of hygienic needles and maintain best practice during the act of facial mark or circumcision. Facial marks are rooted in the history and socio-cultural heritage of our people. We should not forget our history in order for us not to go astray. Panegyrics extolling facial marks are fast dying. The whites still hold on to their tradition and culture.”

A frontline traditional ruler in Osun State, the Owa of Igbajo, Oba Olufemi Fasade, said the Child Right Act would be put to the test in the law courts by parents and guardians. According to the Owa, parental discretion, rather than law, should be employed in determining male circumcision, noting that the art of facial marks was gradually dying a natural death.

He said, “Culture differs from clime to clime. For instance, the burial of kings has its rites; if a government enacts a law to prohibit the rites associated with burial of kings, it might fail because people have their cultural differences and leanings regarding this matter. Facial mark art is dying a natural death because people no longer feel the need for it. Traditional circumcisers could seek legal protection for their profession by challenging the Act if they believe that their trade is under threat.”

The Oludo of Ido-Osun community in Osun State, Oba Aderemi Adedapo, said facial marks were used in the slave trade era ...

A US-based Nigerian medical doctor, Yemi Oladimeji, who owns five dialysis centres in Maryland, USA, said, “There are short term risks of bleeding and infection associated with any surgical procedure. Longer term potential complications include pain on erection, penile disfigurement, and psychological problems. A recent report shows that the non-circumcised adult penis is more sensitive than the circumcised penis, largely because the five most sensitive areas in the male organ are removed during circumcision. This implies a reduction in future sexual sensitivity for circumcised adults. Far from being a harmless traditional practice, circumcision damages young boys.”

Oladimeji said renowned researchers and crusaders against circumcision such as Williams Kaplia, Peterson S, and Sorrells M, in their various works, contend that male child circumcision has continued unchecked throughout the world.

The kidney expert said circumcision phenomenon was a direct tussle between the primacy of parental religious conviction and the primacy of the human rights of the child, the preservation of its bodily integrity, and its right to self determination. Debunking the insinuations that circumcision prevents penile cancer, masturbation, blindness and insanity, Oladimeji said the claims relate to adult sexual behaviour and not genital anatomy or best interest of a child.

“There may be a case that male circumcision reduces HIV risk in sexually active adults, but the decision about whether to have this procedure should be left until the person is old enough to make his own informed healthcare choices,” Oladimeji contended.

The President, Association of Resident Doctors, Ladoke Akintola University Teaching Hospital, Osogbo. Dr Mobolaji Olaoye, said traditional practices like circumcision and facial marks could cause children to bleed to death. “It is high risk to give facial marks or scarify babies, because they could easily bleed to death,” he said.

A nurse in LAUTECH, who spoke on condition of anonymity, said several cases of infection in children resulted from scarification and circumcision, adding that the act disfigures rather that beautifies.

A Muslim parent, who spoke with our correspondent, said, “I have facial marks but I didn’t give my five children any facial marks because facial marks have outlived their usefulness.”

Predicting that Christian parents will defy the law against male circumcision, a pastor of one of the pentecostal churches in Osogbo, Dr Soji Olabisi, said, “The law against male circumcision is a law against God’s commandment. True Christians will resist the law.”

Will Christians and Muslims in the state bow to temporal law, in the face of God’s injunction to circumcise the male child on the eighth day? Time will tell.

It just doesn't cut it

Growing trend not to circumcise Jewish babies less worrying than fact
ritual has become meaningless to secularsTali Farkash

Every once in a while the dilemma
arises again, when a new baby is born to a secular couple. The debate
usually opens with a text message from the exhausted new parents reporting
that ­ mazal tov! - a healthy son was born. The aunt has already decided
what to wear, the uncle is waiting anxiously for the call that would
inform him of where the act, or more precisely ­ the cut ­ is to take
place, but so far no word ­ nada.

After waiting three days, the aunt picks up the courage to call the new
grandma to inquire what's holding things back. "Is the baby okay? Does he
have jaundice?" everything is fine, the grandmother replies, but the
couple has decided not to circumcise the baby.

This gives the cue for the onslaught to begin. The cousin who's a med
student sends the parents a pile of studies claiming that uncircumcised
babies are exposed to various, terrible illnesses; the aunt warns the new
mom that the child would suffer embarrassment at the nursery's toilet and
at the communal shower in the army.

But the new parents insist: Yes to a party, but no to a brit.

Honestly? It's about time. Just like any other Jewish act ­ namely a
mitzvah, and what¹s more a mitzvah that involves inflicting pain on a
helpless eight-day-old baby - the brit milah has also arrived at a
crossroads. And against all criticism and warnings, the decision to give
it a pass is becoming increasingly trendy in Israel.

Circumcision for all the wrong reasons

"I've managed to stand up to the religious, overbearing establishment," is
an old, familiar motto. Only this time, instead of getting married in
Cyprus or holding a non-religious funeral at a kibbutz, we've decided to
keep the boy in one piece, without performing "barbaric" incisions in his
body. What's wrong with that? We have here caring, well-informed parents
who are unwilling to swallow every nonsensical argument that an
over-zealous circumciser tries to shove down their throat at the neonatal
ward.

And even I, a mitzvah observing person, don't have a problem with the
ever-rising number of uncircumcised Israelis. It is beyond my powers to
try and explain to people how much this ritual is imbued with meaning and
speak poetically about its spiritual virtues. I don't see myself preaching
against the dangerous decline of Jewish values over the Knesset podium,
like many religious MKs.

Unfortunately the bottom line is that it doesn't matter whether the boy
was circumcised due to health concerns or because his parents wanted to
make sure he'd fit in with the other kids in kindergarten. The moment that
the brit has been taken out of its religious context and became a social
act that declares one's belonging to a group, instead of a covenant
between God and his children, it has lost its true and appropriate role ­
at least in my view.

I am much more concerned by the fact that many in Israel feel that their
Jewishness is an unwelcomed burden - a redundant, meaningless piece of
information. Just a trick of the universe that has landed them in the
bosom of an ancient, long-suffering nation. They therefore choose to have
the brit without ceremony, or blessings or a minyan. Just make the cut and
get it over with, much like the many who choose not to circumcise their
sons at all. And it is indeed a circumcision, but certainly not a brit ­ a
covenant. [That's where Brit Shalom comes in.]

Tighter regulation of male circumcision advocated

Circumcision of boys has yet to become an international human rights issue
despite the fact that it is a matter of vehement debate in many countries.
Now a Finnish human rights group wants to take part in a public discussion
on the practice. Nonmedical circumcision of boys, providing it is
performed properly, is permitted in Finland. In 2003 a working group set
up by the Ministry of Social Affairs and Health prepared a memorandum on
the matter, which recommended that circumcision of boys be permitted under
certain conditions. This recommendation has yet to translate into an
official clarification in law, however.

Kristiina Kouros, Secretary-General of the Finnish League for Human Rights
(IOL), considers legal clarification of what is and is not permitted with
regard to male circumcision to be of utmost importance, emphasising that
the League does not support outright criminalisation. The procedure is not
currently banned in any country.

"We don't advocate criminalisation of male circumcision since it would
continue to be performed regardless. [Yet female genital cutting is criminalised, and those who continue to perform it regardless are punished.] Instead, we¹re emphasising above all
that legislation be used to protect boys from facing circumcision in
unprofessional and unsafe circumstances."

The IOL believes that any new legislation or guidance should specifically
define the circumstances in which nonmedical circumcision of boys may be
performed, who may perform the procedure, and according to which
conditions. At the same time, the IOL argues, the legislation should
detail penalties for cases where these guidelines are not followed. On 18
December the League published its official stance on male circumcision in
which it declared cessation of the age-old practice to be its long-term
goal.

Kouros does not consider this goal unrealistic. "Eliminating such a
widespread tradition will take time, but in the long-term it¹s not
impossible," she says.

As yet, there are no concrete plans to introduce legislation regarding
male circumcision, but the Ministry of Social Affairs and Health has
declared that it will reexamine the matter some time next year.

Traditional circumcision raises risk of infection, study shows

By Ofri Ilani

Circumcision as performed by mohels, men whose profession is performing the Jewish ritual of brit milah, leads to a high rate of urinary tract infections among babies, according to a report released recently by physicians at Schneider Children's Medical Center in Petah Tikva.

The vast majority of Israeli Jews have their children circumcised by mohels. The religious obligation aside, many parents consider the ceremony of removing the foreskin to be hygienic and healthy. However, the study by the Schneider physicians, published in the pediatric journal the Archives of Disease in Childhood and headed by Prof. Yaakov Amir, found that circumcision conducted by a mohel leads in many cases to infections of the urinary tract that can significantly endanger the baby.

The researchers believe the infection is caused by the bandage left on the penis after circumcision. "For several years, we have noticed a wave of urinary tract infections among very young children - usually from the age of eight days on," Amir said. "We decided to investigate the phenomenon, and obtained figures from several hospitals."

Researchers identified 162 cases of babies under two months old undergoing hospitalization for urinary tract infections. Of these, 108 were boys and 54 girls. "We saw the same phenomenon in each hospital - a wave of urinary tract infections around the ninth day after pregnancy," he said.

"By contrast, among girls there was no such wave, but a gradual rise in cases over the first year of life. So it was clear to us that this issue is related to circumcision."

In addition, they found urinary tract infections to be far more common among babies who had undergone circumcision by a mohel rather than a physician. "There are children in Israel who undergo circumcision by a doctor. We saw that there is less infection among them than among those who had the procedure performed by a mohel," Amir said. "Without appropriate and intensive treatment, the bacteria could reach the blood, possibly even causing death."

"When the mohel finishes cutting, he takes a piece of dressing and wraps it around the member. That's the root of the problem - the bandage doesn't allow the baby to urinate completely. The baby sometimes stays for 15 or 20 hours with this bandage, and if the circumcision is performed before Shabbat, it is sometimes two days before the mohel removes the bandage," Amir added.

Menachem Fleischman, a mohel who supervises new members of the profession in the central region of the country, said they must be aware of the effect the bandage could have. "It is preferable that the bandage does not press too hard. One must pay attention, and a mohel who is adequately trained will make sure to surround the area with special cotton wool right after cutting."

More than a snip

Re-examining Infant Circumcisionby Angela Starks

Being from England, I reached adulthood without even knowing that there was such a thing as the routine circumcision of newborn boys. In Europe it is rare, and it is estimated that between 80 and 95 percent of men worldwide are uncircumcised. But when I married an American and gave birth to a boy in the Hudson Valley, I learned that most boys are circumcised as a matter of course in the US. I informed my husband that I was against it for our child and he agreed. ...

... the fact that a baby cannot give his own informed consent bothers activists such as Georganne Chapin, a health care executive and attorney who has taught bioethics. She is leading the formation of Intact America (www.intactamerica.org), a new organization, based in Tarrytown, dedicated to abolishing infant circumcision. Ms. Chapin’s own prediction is that “it will only be a short time before we realize that circumcision cannot cure our ills, and coercing vulnerable people to give up a critical part of their anatomy is a bioethical travesty.”

The kindest cut: How circumcision is the secret weapon in the battle against HIV/Aids

In Zambia, an experiment in the battle with HIV/Aids is producing staggering results. If this were a vaccine trial, the medical world would be hailing it as a miracle. But instead of a wonder drug, the secret weapon is circumcision. Jeremy Laurance reports

After weeks of waiting, Michael Phiri decided to take matters into his own hands. The 16-year-old from George Compound, a township outside Lusaka, was so anxious to be rid of his foreskin, and so frustrated after being turned away from the circumcision clinic at the University Teaching Hospital for the third time, that he took a bread knife and did the job himself. The resulting bloody mess had one positive outcome; it sent him straight to the top of the queue for surgery, and he got his operation performed, as an emergency, by the urology specialist Kasonde Bowa.

"He had made a good start, with a dorsal cut as far as the rim of the glans, but things had got difficult from there," a smiling Dr Bowa says, with admirable understatement.

As Zambia's leading expert on circumcision, Bowa tells this story (the patient's name has been changed) to illustrate the soaring demand for the procedure that is sweeping Lusaka and other towns across sub-Saharan Africa, as word spreads of its remarkable preventive power.

[Yes, and the panic at Orson Welles' 'War of the Worlds' proves there really WAS a Martian invasion.]

Circumcision, if rolled out across the continent, offers the first real prospect of saving lives by preventing infection on a significant scale. [The total number of cases supposedly prevented - or more accurately, deferred - in the three trials, involving 10,908 men, is - 73.]

...

Surveys have shown wide acceptance of the procedure and increasing interest among parents wanting the operation for their children. [Cutting parts off is easy when it's someone else's parts.]

... President Yoweri Museveni of Uganda dismissed the proposal as the West's latest "golden calf" which Africa was expected to worship and warned that it could suck resources from other preventive strategies (a concern shared by some of the charities I spoke to).

... In sub-Saharan Africa, the main driver of the epidemic is multiple concurrent relationships – the practice of taking several lovers at the same time. ...
Critics fear that circumcision will encourage men to think they are immune and to ignore safe-sex advice, so increasing risks.
...

At the Society for Family Health's clinic, men are offered an HIV test before the operation, and more than 80 per cent accept the offer. Calls for the test to be made mandatory have been rejected because of concern that it could deter people from seeking the surgery. [And the ones who refuse to be tested are the ones most likely to be infected...]

...

If something goes wrong, can they sue him for practising medicine without a licence?

Christian parents seek out 'holistic circumcisions'

By NICOLE NEROULIAS Religion News Service

Mark Kushner pulled up to the Watson family’s suburban Philadelphia home a week after the birth of their first son, Colin. In the dining room, he unpacked the tools of his trade: sterilized surgical instruments, topical anesthetic, prayer shawls and a small bottle of kosher wine.

The shawls went back into his black bag. But to Megan and Christopher Watson’s happy surprise, the mohel — pronounced “moyle,” the title for a Jewish ritual circumciser — had copies of several prayers appropriate for the Presbyterian parents to read for the occasion.

“We thank you for the miracle of human experience in the birth of our child,” they recited, as Kushner gently rocked their infant before the procedure. [This part of the miracle of human experience the baby would probably rather go without if he had a choice.]

Kushner, who is based in Philadelphia, and Philip Sherman, a mohel in the New York City area, say they have performed more than 30,000 circumcisions since training together in Israel in the 1970s. Most of their business comes from traditional brit milah ceremonies for 8-day-old Jewish boys. But in recent years, they have increasingly catered to Christian families who eschew a hospital procedure in favor of a $300 to $800 house call — a trend Sherman has dubbed “holistic circumcision.” [Giving it a New Age woo-woo name makes no difference to the baby. They could call it "teddy bear circumcision" and it would still be the same old genital cutting.]

“They want their babies circumcised in the comfort of their homes surrounded by family and friends, and they want it performed by someone highly experienced, who brings spirituality and meaning to the practice,” he said. “And it’s over in 30 seconds, compared to what hospitals do, which can be from 20 to 45 minutes, with the baby strapped down.” [...waiting for the anaesthetic to take effect.]

Many Christian clients, including the Watsons, liked what they saw at a friend’s brit milah, also known as a bris. Others are conservative Christians who want to follow Old Testament tradition [rejecting the New Testament is generally considered radical in Christians...], or learned about holistic circumcisions from the Internet, their doctors or word-of-mouth, Kushner said.

Yet this anecdotal rise in Christians calling on mohels comes as the U.S. circumcision rate — historically much higher than in other parts of the world — is in decline. In contrast to the 85 percent reported in 1965, just 65 percent of all male newborns in American hospitals were circumcised in 1999, according to the most recent figures from the National Hospital Discharge Survey. Reliable data on religious circumcisions outside hospitals is hard to come by.

Medical studies suggest circumcision may reduce the risk of penile cancer, urinary tract infections and HIV transmission. [From what, to what? Other medical studies suggest it may not.] But since 1999, the American Academy of Pediatrics has stated there is “insufficient data to recommend routine neonatal circumcision.’’

Critics argue the procedure causes physical and psychological pain to a child and diminishes sexual pleasure for adults, regardless of whether the foreskin gets removed in a clinical setting by medical residents or during a brit milah among loved ones.

“It makes no difference to the child who does the cutting, or what is hanging on the wall,’’ said Ronald Goldman, executive director of the Circumcision Resource Center in Boston, and author of two books opposing the practice for Jews and non-Jews alike.

Goldman, who compares circumcision to removing a fingertip, believes “it’s still traumatic. It still removes a natural, healthy, functioning body part.’’ Many families continue the trend only because men want their sons to look like them, he added, and the women don’t feel that it’s their place to argue.

Megan Watson acknowledges that she had mixed feelings about having Colin circumcised, but deferred to her husband’s judgment. [Unfortunately, every child has two parents and it only takes one....] At least at home, she said, they could comfort their son throughout the process, and she could breast feed him soon afterwards.

As Christopher Watson held his screaming baby’s legs still on the tabletop pillow, Kushner snipped the foreskin off the tiny penis. The process took less than a minute.
...

Circumcision in spotlight

A meeting in Johannesburg with a national Aids body and other concerned groups today will put the spotlight on the merits [and the demerits?] of male circumcision in preventing HIV infection.

The forum will include the South African National Aids Council, traditional leaders and civil society organisations.

They will discuss how male circumcision can be implemented in HIV-Aids prevention and treatment policies.

However, Sanac's Sue Goldstein excludes "traditional" circumcision done during initiation ritual. With traditional circumcision, the entire foreskin is not removed, said Goldstein [text missing, perhaps ", and she"] warned that circumcised men were not immune to the virus. [text missing, perhaps "Nor does it offer"] protection to people in homosexual relationships.

[But the entire foreskin was not removed by the forceps-guided method used in the South African or Kenyan randomised controlled tests either - yet the "protection" it gave was as great as that in the other test, in Uganda - which throws the claim that circumcision caused the "protection" into considerable doubt.]

"We would like to help the public by providing empirical and tested information to help make educated choice on health issues, especially around HIV-Aids," said William Mapham of the Reproductive Health and HIV Research Unit. - Namhla Tshisela

Science Versus Religion: Circumcision Debate

Reporting
Sally Thorner

BALTIMORE (WJZ) -- A circumcision debate is pitting science against religion. It's the same basic procedure whether it's done in the hospital or the home but, as Sally Thorner explains, there is one major difference.

Two babies--both newborn boys--are having very different experiences. Like 70% of [US adult] males, they are circumcised, but their response is pitting science against religion. What's up for debate is the management of pain during their surgeries.

"The moment that we are waiting for," said Rabbi Moshe Rappaport. "It might be a little uncomfortable, and at the same time, it might be very magical." [And we all believe in magic, don't we?]

In the Jewish religion, a Mohel performs the ritual circumcision, called a bris. Rabbi Rappaport minimizes the baby's pain with a numbing solution and wine for the baby to suck on.

"There's something right when the baby has a natural reaction to a bris and cries for a short time," he said.

While the ritual circumcision typically happens in the home when the baby is eight days old, the medical circumcision happens in a hospital soon after the baby is born.

A baby in the hospital is given Tylenol and sucks on sugar water. The big difference is they receive an injection to numb the entire area.

"It's inconceivable to me that there are even questions about this anymore," said Dr. Myron Yaster.

Dr. Yaster is a pediatric anesthesiologist and an Orthodox Jew. As a physician, Yaster's views on babies and pain trump his religious beliefs.

"Historically, it was long believed that babies or newborns did not feel or remember pain to the same degree that older children and adults do," he said. "We now know that that's completely incorrect."

In a recent study, Canadian researchers found that boys who are circumcised without pain relief are more sensitive to pain later in life.

"The parents are the consumer here. [No, actually, someone else is - but "consumer" is hardly the word. "Victim" is.] Do they want their child to experience the pain or not? There are techniques that are available, very easy to do, very simple that will eliminate the pain," Dr. Yaster said.

"You have to separate belief from fact," Dr. Yaster said. "There is belief that my children need to be circumcised but there's also fact: I don't have to do it painfully." [Or could the fact be that they don't need to be circumcised?]

Methods even differ from doctor to doctor. Not every procedure includes a shot to block the pain. Some believe the pain from the shot is as bad as the circumcision itself, so if you decide to circumsize [Should you trust an article about circumcising by someone who can't spell it?] your son, you should ask the doctor or the Mohel how he or she plans to control your baby's pain.

Mass testing plan to tackle Aids

A radical new strategy to stop the Aids epidemic in its tracks was proposed yesterday by World Health Organisation scientists but ran into immediate controversy over its implications for human rights.

The plan involves testing everybody for HIV every year in hard-hit areas like
sub-Saharan Africa and immediately putting those who are positive on Aids drugs. It could slash dramatically the number of new infections, because Aids drugs lower the levels of virus in the body, making HIV transmission through unprotected sex much less likely.

But the strategy, expounded in a paper published online today by the Lancet medical journal, raises major issues both over implementation and over ethics.

Currently people who are HIV positive are not put on treatment until they need it, because of the toxicity and side-effects of antiretroviral drugs. It raises the prospect of subjecting people to potential medical harm for the public good, rather than their individual benefit. "We wouldn't do that in the UK," said John Howson of the International HIV/Aids Alliance. "These are huge issues."

The authors of the paper include Kevin de Cock, HIV/Aids director at the WHO, who points out that this is a mathematical model for discussion, but says it offers hope at a time when other avenues appear to have closed. If this could be implemented in sub-Saharan Africa, he told the Guardian, "the proportion of people with HIV would run to under 1% in less than 50 years".

In an accompanying editorial in the Lancet, Geoffrey Garnett and Rebecca Baggaley, of the department of infectious disease epidemiology at Imperial College London, say the strategy would be "extremely radical, with medical intervention for public health benefits rather than individual patients' benefits".

It "would reflect public health at its best and at its worst", they say. Treating people earlier could benefit them and protect their partners[unlike you-know-what], but could also expose them to over-treatment and side-effects. "Challenges will rightly come from those concerned about individuals' rights and patient autonomy, as well as from those who moralistically fear an 'easy' solution to HIV rather than behavioural change."

Howson said more effort should be put into interventions known to work, such as circumcision, which can reduce transmission by 60%. "It is important and really interesting," he said. "Let's do some research, but look at the implementation of those other things first."

Indoctrination

November 24, 2008

Women to [be persuaded to] promote male cut

By JOHN NGIRACHU

Spurred on by reports of a significant increase in HIV infections among married couples, health officials want to involve women in the drive to have more Kenyan men undergo circumcision.

Speaking at the launch of the voluntary male circumcision programme at Panafric Hotel, Nairobi on Monday, Public Health and Sanitation assistant minister James Gesami said the ministry would provide free counselling for couples on the benefits [but not the detriments] of male circumcision.

Counselling will be part of Government's strategy to promote the male cut in Kenya, partly funded by the Bill and Melinda Gates Foundation and the US Government.

This follows recent release of data from the Kenya Aids Indicator Survey that shows two-thirds of Kenyan adults infected with HIV are legally married or cohabiting and that in one of every 10 marital unions, at least one partner is living with HIV, forming what doctors call 'discordant couples'.

Married couplesDr Peter Cherutich, head of the national task force on circumcision, said counselling is critical for both married and unmarried couples.

"There are cases where the husband sneaks out for circumcision and the wife interprets that to mean that he is preparing to become promiscuous, or that it will have an impact on their sexual relations [as it will]... Women have to be involved for the full benefits to be felt," Dr Cherutich said.

He said the one-month healing period may also create problems as women may not understand the need for prolonged abstention from sex.

Parents will also be advised on how to counsel their sons facing "the cut."

Research has also shown that the male cut markedly reduces chances of infection with the human papilloma virus that causes genital warts and cervical cancer - the leading cause of cancer-related deaths in Kenya - by between 60 and 70 per cent.

The foreskin is a grey area

Male circumcision is part of the religion of many Jews and Muslims.
However, opponents of the practice claim that it is seldom legal. Now a
controversy over discrimination has flared up.

By Cigdem Akyol

This little boy thinks that circumcision is stupid, too.

For some it is just a small cut, for many Jews and Muslims, it's an
important procedure: The removal of the foreskin. Religious circumcision
has now triggered a controversy between the Islamic community Milli Görüs
(IGMG) and authors contributing to the German physicians' paper
Ärzteblatt. Engin Karahan of IGMG, which represents 87.000 members,
accuses the authors of an article, published in August, of severe
discrimination and paternalism.

In the essay "Criminal consequences even when religiously founded", the physicians Maximilian Stehr, Hans-Georg Dietz and the lawyer Holm Putzke advice against religious circumcisions without medical necessity. They
argue that the removal of the foreskin is "not just an insignificant
physical loss, and it is therefore a violation of bodily integrity". By
performing it, the operating surgeon could be commiting an offence of
bodily injury. Whether a physician practicing in Germany is obliged to
circumcise children for religious reasons hasn't been legally regulated
yet. While critics refer to the endangerment of the children's physical
integrity, proponents argue with the fundamental right to freedom of
religion.

Because of this legal grey area, there is no uniform procedure in
Germany. Karahan gives an account of desperate parents who are not able to
find a specialist to perform the circumcision of their sons. In 2006, a
Turkish pensioner was fined in Düsseldorf because he had circumcised small
boys even though he didn't have a medical education. In his defense, the
man said that he would be considered a respected circumciser in Turkey.
There, it would not be the physicians' responsibility to perform these
procedures.

Holm Putzke knows that his article has hit a nerve that is already
frayed. "Freedom of religion is not unrestricted", Putzke says and warns
about a legal vacuum in an area concerning fundamental rights. "We must be
able to discuss a taboo topic, too. Because this is the only way
integration [of immigrants] will work." Karahan doesn't understand this
perspective, though. On the contrary: He accuses the lawyer of partiality
and lack of understanding. "A similar article by Putzke was sent to many
physicians without solicitation. What does he intend with this action?",
Karahan asks. "If I wrote an article about livestock breeding, I wouldn't
send it to all farmers." [If it warned that some methods of livestock breeding could be illegal, one might.]

Ulrich Hofmann, president of the German Society for Child Surgery, is familiar with the heated debate. "We are in Germany, and here German right is valid", he
says. His recommendation for his colleagues is to cover themselves with
contracts. Because one day, the circumcised might sue the physicians.

Iraq's Kurdish areas prepare to ban female circumcision

ARBIL, Iraq (AFP) — Parliament in Iraq's northern autonomous region of Kurdistan is preparing to outlaw female circumcision, according to a woman MP and doctor who has long battled to halt the widespread practice.

"A bill making circumcision illegal will be presented in parliament over the next few days," Dr Hala Suheil told AFP, saying it would impose jail terms and fines on offenders.
...

"This practice began in the region so long ago, and we have no idea where it comes from. But the ancients justified it by saying it would preserve a girl's chastity," said Dr Suheil, adding that no precise statistics are available.

"Old women circumcise young girls using barber's razors and even shards of glass, often causing terrible haemorrhaging and sometimes death," the MP said.

Sheikh Sayyed Ahmad Abdel Wahab al-Panjawini, imam of Arbil's Hajj Jamal mosque, said "iIt may be an old custom, but it has nothing to do with Islam.

"No religious text mentions this practice. It is a custom that some have introduced to the Muslim way of thinking."

In a recent article in the Kurdish daily newspaper Hawlati, the secretary general of the Islamic Women's Union, Bekhal Abu Bakr, wrote that "female genital mutilation is not a Muslim practice."

"Many of the problems experienced by women are the result of erroneous traditions, and Islam is not to blame," she said.

"Sharia (Islamic law) is a long way from such practices, and circumcision exists because some people interpret the Koran in a false manner," she said, alluding to obligatory male circumcision. [Male circumcision is not mentioned in the Qu'ran.]

Male circumcision should be cut

While there are laws preventing female genital mutilation in Denmark,
there are none preventing male genital mutilation. Demands for action.

The Children's Council and the Chair of the Ethical Council say it is
objectionable and ethically indefensible that while there is a law
preventing female genital mutilation, no such law exists for males.

Both the Jewish, Muslim and other traditions call for the circumcision of
males. In Denmark, the Chief Rabbi Bent Lexner carries out the
circumcision of Jewish boys. Muslim circumcisions are often carried out in
clinics or hospitals.

Religious linksThe Children's Council Chair Charlotte Guldberg says the practice should
be stopped.

"There is a deep problem here. Society is in no doubt that the genital
mutilation of girls is unacceptable - but we accept it with boys and have
tolerated it for many years because it is linked to religion. It is gender
discrimination from birth that we make a distinction between boys and
girls," says Gulberg, who adds that circumcision should be banned for boys
under 15 years of age. According to tradition, young Jewish boys are
circumcised at the age of eight days.

VoiceThe Ethical Council does not have a general view of circumcision, although
Chairman Peder Agger does not immediately reject the notion of
legislation.

"There is an ethical problem. I would prefer people to wait until the
child is 15, thus respecting his right to choose and so that he knows what
is going on. I believe that one should not undertake physical procedures
that leave lasting scars or have lasting effect until a child is 15. And
there should be some discussion as to whether the procedure should be
ritualised in another way. In Denmark we have also stopped putting a
child's head completely under water during baptism," says Agger.
...

Listen, boys: the snip is just a false sense of superiority

Andile Mngxitama says initiation is not culture but a backward, useless tradition that should be broken

Our collective reaction to the abduction, frog-marching and mutilation of Fikile Mbalula into manhood calls for reflection on the national values that we want to cultivate and instil in our young men.

We fail to undertake such a process at our peril, especially now that our national political discourse is tainted with the “tribal” poison. When Mosiuoa Lekota says the “ANC is run by boys”, we know he is directing his message to the primordial Xhosa chauvinism which militates against being led by the uninitiated.

But therein lies the contradiction.

Although Lekota is railing against tribalism, he is at the same time saying that until a Xhosa male is initiated, he cannot be regarded as a man and therefore cannot be charged with the responsibility of running the ANC. He is, in other words, reinforcing a useless and dangerous throwback tradition that continues to pass as culture.

What happened to Mbalula is a national disgrace and an act of sheer callousness, a vile manipulation of “culture” to serve narrow, provincial party-political ends.

Foreplay may be overrated according to a survey based on 2,300 women,
which found that it has little or no significance when it comes to the
likelihood of [them] having an orgasm.

By Roger Dobson

The duration of intercourse – 16.2 minutes on average – is the
clincher, according to the research. The findings suggest that sex
therapists, who emphasise the value of foreplay, may have that been
getting it wrong. "In contrast to the assumptions of many sex
therapists and educators, more attention should be given to improve
the quality and duration of intercourse rather than foreplay," say
Professor Stuart Brody of the University of the West of Scotland, and
Professor Peter Weiss, from Charles University, Prague. In the study,
reported in the Journal of Sexual Medicine, the academics quizzed a
representative sample of 2,360 Czech women of all ages about details of
their sex lives, including orgasmic consistency with a partner along with
estimated duration of foreplay and intercourse.

Results show that for the women in the study, the average duration of
foreplay was 15.4 minutes, and intercourse, 16.2 minutes. The researchers
point out that 16.2 minutes is considerably longer than reported in
American studies, where intercourse was found to last on average seven
minutes. They added: "It could be that this reflects, a greater
appreciation of intercourse and sensuality by Europeans than by
Americans." [Hmm, any other difference between Czech men and American men... ?]

The researchers looked at frequency of orgasm in the women, and
foreplay and intercourse data. They concluded the links with foreplay were
insignificant. Instead they suggest that the longer intercourse lasts, the
greater the probability of orgasm for the women.

"This was a large number of women and the results are robust," says
Professor Brody. "Sex therapists and educators put the overwhelming
emphasis on foreplay, but they need to be guided by the evidence which
shows that it is not the case. "Intercourse is significantly more
important. Our findings should lead researchers, educators, and clinicians
to reconsider the contributions of foreplay and intercourse."

Bua Newscompiled by the Government Communication and Information SystemNovember 6, 2008

EC to open private wards for botched circumcisions

By Gabi Khumalo

Eastern Cape - The Department of Health will soon provide private wards in hospitals throughout the Eastern Cape Province to accommodate patients who are admitted to hospital due to botched traditional circumcisions.

Health MEC Pemmy Majodina made the announcement to 4 000 residents in Lady Frere attending the National Council of Provinces (NCOP) Parliamentary seating in the Chris Hani District Municipality.

MEC Majodina told residents that the department wanted to separate the patients while giving dignity and upholding the customs and cultures of South Africans.

"We can no longer mix the people who are coming from circumcision schools with those that have not gone to the circumcision schools in our hospitals due to certain complications," she said.

Ms Majodina said the mandate of her department was to save the lives of people noting that her department could no longer afford any deaths during the circumcision period.

"The young people who undergo circumcision are the future of this province and if we want to grow the economy of this province, we need to make sure that they return from the circumcision schools healthy," she said.

In April, the department appealed to communities and parents in the province to report illegal initiation schools to the police and the department while ensuring that no more young boys.

This follows the death of four boys after being rescued from various initiation schools in the province.

Themed "Parliament Empowering Communities for Poverty Eradication", the NCOP is in Lady Frere for the week to listen to the people as part of its programme of taking parliamentary sessions to the people.

Over the next few weeks hundreds of young boys throughout the Eastern Cape are expected to flock to circumcision schools to seek passage to manhood.

...

Sanity

South African Medical JournalOctober 2008, Vol. 98, No. 10
, 2008

Male circumcision and HIV infection

Clutching at straws to prevent the HIV/AIDS epidemic
has included strident advocacy for male circumcision (MC)
from some quarters, especially following three randomised
controlled trials from South Africa, Kenya and Uganda in 2006
- 2007 that show a protective effect of MC. Three contributions
in this SAMJ contest the value of MC in the prevention of HIV.

Connolly and colleagues1 analysed a sub-sample of
men aged 15 years and older who participated in the first
population-based survey on HIV/AIDS in 2002. Of the men
35.3% were circumcised. The factors strongly associated
with circumcision were age >50, rural blacks and speaking
SePedi or IsiXhosa. Blacks were significantly older (mean 18
years) compared with other race groups (3.5 years). Among
blacks, circumcisions were mainly conducted outside hospital
settings. Since they found that circumcision and HIV were not
associated, they concluded that MC had no protective effect in
the prevention of HIV transmission. They also noted that most
circumcisions among indigenous ethnic groups in South Africa
are conducted under unsterile conditions.

Non-therapeutic, non-religious circumcision is the surgical
procedure most commonly published about. Sidler, Smith
and Rode2 note that substantive indications for the procedure
are lacking and review the evidence for the possible value of
neonatal circumcision in reducing HIV infection rates. They
cite reviews that question the necessity of non-therapeutic
infant circumcision, showing that it has neither short- nor
long-term benefits, and other reports that circumcision does
not prevent sexually transmitted diseases. On this basis they
conclude that neonatal non-therapeutic circumcision to combat
the HIV crisis in Africa is neither medically nor ethically
justifiable. Furthermore, promoting circumcision might worsen
the problem by creating a false sense of security and therefore
undermining safe sex practices. Education, female economic
independence, safe sex practices and consistent condom use are
proven effective measures against HIV transmission.

The accompanying editorial by the Myers team of father
and son3 largely concurs with the findings of the two papers.
They therefore suggest that the duty of parents may to be err
on the side of caution, and defer the procedure until the child
can make an autonomous decision. At a societal level MC
may be unjust in so far as it could compete for resources with
more effective and less costly interventions and disadvantage
women.

Neonatal circumcision does not reduce HIV/AIDS infection
rates

D Sidler, J Smith, H Rode
Non-therapeutic, non-religious circumcision is the surgical
procedure most commonly published about,1 but substantive
indications are lacking. Since its introduction to the USA
during the Victorian period, when it was thought that it
prevented masturbation,2 medical justifications for the
procedure progressed to prevention of various infective
conditions (sexually transmitted diseases, penile and cervical
cancer) and controlling of the sexual drive.
...

ConclusionMale non-therapeutic infant circumcision is neither medically
nor ethically justified as an HIV prevention tool. Circumcision
is not equivalent to successful immunisation, is being practised
with decreasing frequency in English-speaking countries, and
is becoming illegal in South Africa under the new Children’s
Act.32 There are far more effective prevention tools costing
considerably less and offering better HIV reduction outcomes
than circumcision.

Finally, the WHO and UNAIDS appear to be basing these
multi-million-dollar prevention programmes on limited and
in some instances biased information. In order to prevent
confusion and parents making misguided decisions on behalf
of their infants, and to offer effective help in alleviating the
suffering that is being created by HIV/AIDS, a much broader
review process would be called for. Such a process would
involve more objective scientific opinion, and the involvement
of a representative panel of African experts, such as paediatric
surgeons and neonatologists.

Two articles1,2 published
in this issue address male circumcision
(MC).

Connolly et al.1 show in a national survey that MC, whether
pre-pubertal or post-pubertal, has no protective effect
on acquisition by males of HIV infection as measured by
prevalence.

Sidler et al.2 state that neonatal MC continues to be promoted
without adequate justification as a medicalised ritual, via an
HIV prevention rationale. They caution that for MC to be a
therapeutic as opposed to a non-therapeutic procedure, it is
necessary to gather more corroborative and consistent evidence
of its benefit, consider the potential harms (psychological,
sexual, surgical and behavioural/disinhibition), examine the
ethical implications, and examine effectiveness and efficiency
(costs and benefits) at the population and societal levels. They
point out that MC is not just a technical surgical intervention
– it takes place in a social context that can radically alter
the anticipated outcome. At the 2008 International AIDS
Conference3 in Mexico cultural, political and educational issues
raised by the intervention, such as decreased condom use and
marginalisation of women, were hotly debated. Some cultural
interpretations may view MC as a licence to have unprotected
sex. A case in point is Swaziland, where men are flocking to
be circumcised with the understanding that this means they
no longer need to use other preventive methods (e.g. wear
condoms or limit the number of sexual partners).4

The 2003 Cochrane review5 of observational studies of MC
effectiveness concluded that there was insufficient evidence
to support it as an anti-HIV intervention. Three randomised
controlled trials (RCTs) from South Africa, Kenya and Uganda
in 2006 - 2007 show a protective effect of MC. However,
Garenne6 has subsequently shown from observational data that
there is considerable heterogeneity [inconsistency] of the effect of MC across
14 African countries. Despite the South African RCT showing
a protective effect, he reports for the nine South African
provinces that ‘there is no evidence that HIV transmission
over the period 1994 - 2004 was slower in those provinces with
higher levels of circumcision’. Interestingly, in both Kenya
and Uganda, where two of the RCTs were done, a protective
effect of MC was observed, but a harmful effect was observed
in Cameroon, Lesotho and Malawi. The other eight countries
showed no significant effect of MC.

These somewhat discordant findings are difficult to interpret.
While RCTs are theoretically strong designs, it is conceivable
that their findings are not generalisable beyond their settings.
Furthermore, there have been no trials of neonatal MC. Study
flaws such as inability to obtain double blinding, and loss
to follow-up in RCTs, may effectively degrade their quality
to that of observational studies. Meanwhile other disturbing
findings referred to by Sidler et al. are emerging, including the
reported higher risk for women partners of circumcised HIVpositive
men, disinhibition, urological complications, relatively
small effect sizes of MC at the population level, and relative
cost-inefficiency of MC.

Not all objections to MC as an HIV intervention have to
do with evidence of effectiveness or cost. Sidler et al. raise
ethical objections. Owing to the current climate of desperation
with regard to the HIV epidemic, evidence in favour of MC
frequently seems overstated. This reduces the scope for
informed consent and autonomy for adult men considering
the procedure. Further problems arise in the case of neonates
whose parents may be considering the procedure. Whereas
informed consent is at least possible for adult men, it is
clearly not possible for neonates. Parents can only guess what
the child’s wishes would be if he were presented with the
information they have at their disposal. If it could be shown
that circumcision was necessary in the neonatal period,
parental consent on behalf of the neonate would be justified.
But since no valid surgical indications for circumcision exist
in this period, and the future benefit to the child in respect of
HIV avoidance is not relevant before sexual debut, the duty of
parents may well be to err on the side of caution, and defer the
procedure until the child can make an autonomous decision.
In the absence of compelling indications, a procedure such as
circumcision could also be seen as a violation of the child’s
right to bodily integrity. Furthermore, the ethical principle of
non-maleficence cannot be upheld as there are clear harms
attached to this practice, to which Sidler et al. refer in their
article. Lastly, at a societal level MC may be unjust insofar as it
could compete for resources with more effective and less costly
interventions7 and disadvantage women.

Despite a strong pro-circumcision lobby driven by
enthusiasts who have been promoting MC as an (HIV)
intervention for many years, and impatience expressed by
protagonists about the long delay after the 2006 - 2007 RCT
results and the UNAIDS/WHO policy recommendations8
of March 2007, few mass campaigns have been launched in
African countries.

Given the epidemiological uncertainties and the economic,
cultural, ethical and logistical barriers, it seems neither justified
nor practicable to roll out MC as a mass anti-HIV/AIDS
intervention.

A MyersHumanities student, University of Cape Town

J MyersSchool of Public Health and Family Medicine
University of Cape Town
Corresponding author: J Myers (jmyers@iafrica.com)

Uganda Health News: UCA to study male circumcision

The Executive Director of the Uganda Aids Commission (UCA) Dr. Kihumuro Apuuli has said that starting next month the organization will conduct research on the effectiveness of male circumcision on preventing the spread of HIV/AIDS in the country.

The disease is one of the leading causes of deaths in the country and the recent World Health Organization (WHO) report indicated that the prevalence rates have increased in the country despite government efforts to control it.

HIV/AIDS is mostly affecting women, children and the poor people especially in the rural areas which lack adequate medical facilities.

The UCA boss told journalists in Kampala yesterday that if the study is successful, it will help to compl[e]ment the existing ABC strategy.

Meanwhile, experts are skeptical on the new strategy recommended by WHO, they argue that HIV/AIDS prevalence rates is still high [in] Muslim dominated countries where the majority are circumcised.

The fight against HIV/AIDS in Uganda has been hampered by poverty, high illiteracy rates, bad cultural practices and corruption in the health sector.

The three former ministers of health Jim Muhwezi, Mike Mukula and Alex Kamugisha are still facing charges for mismanaging billions of Global and GAVI funds money meant for the treatment of HIV/AIDS, Tuberculosis, Malaria and Immunization.

The Secret World of Female Circumcision

- Juliet Torome

NAIROBI - As a child in rural Kenya, I was a secret admirer of female genital mutilation. I was swayed by talk of friends and elders about how once a girl undergoes "the cut," she gains respect and grown men consider her suitable for marriage. Perhaps these were the reasons why, as a girl of 13, I longed to be "circumcised" and become a "real woman."

My mother opposed the practice, however, because she was (and remains) a Christian and wanted me to become educated and to escape the fate of many girls in my community who are married off to older men and then lose their autonomy. I tried to persuade my mother to permit my circumcision, but she refused.

My mother's decision angered me. In frustration, I spoke with a few other schoolgirls. Each of them gave a different version of the process, but they held a common view: circumcision is intensely painful, and I must be prepared for much bleeding. And yet the friends to whom I spoke encouraged me to get circumcised.

So one August, during my school holidays, I decided to learn more about female genital circumcision. I decided to witness a girl undergoing the practice, and perhaps see her cry and bleed. If possible, I would talk to her later in order to gain a clearer picture of her experience.
I

went ahead with my plan and witnessed a girl being circumcised. The experience changed my life, but not in the way I expected. Before the operation, traditional heroic songs were sung, while a few older women sharpened their knives, preparing for the task ahead. They also prepared special herbs for use as disinfectants. I paid little attention to their preparations, actually. My eyes were fixed on Lillian, a girlfriend who was waiting to be cut.

When the women began their work, Lillian's expression turned from giddy anticipation to fear and then panic. I thought she might change her mind and run for her life.

I was mistaken. She sat on a traditional stool and spread her legs wide apart. An old woman bent over her, knife in hand. I looked away and heard a sharp scream. The scream was swallowed by cheers from scores of women watching Lillian with me. They celebrated Lillian's mutilation, while I mourned her loss.

In my mind, Lillian was experiencing the worst moment of her life. In an instant, my view of female circumcision changed forever. While the women around me kept cheering, I resolved that from then on I would resist the practice with all my might.

Because of my mother's support, and my own determination, I succeeded in keeping my body intact. I went on to finish high school and then study journalism in a big city far from home. Today, living and working in cosmopolitan Nairobi, I look back with a mixture of horror and bemusement on my girlhood fascination with female circumcision.

I escaped mutilation, but other girls from my rural Kenyan community continue to receive "the cut" to this day. Only last month, in Narok, the town nearest my childhood village, a 13-year-old girl died after undergoing circumcision as a preparation for her marriage to a man who already had five wives. When the girl died, her father and fiancé conspired to have her body secretly buried in the bush. Kenya's police learned of the girl's death and legal action is being prepared against the men.

But punishment for the perpetrators of female circumcision remains rare. The practice persists, despite legal bans. As a child-welfare officer in Narok told me, "Unless attitudes are changed, efforts to stamp out the practice will be futile."

Parents' attitudes are changing, but slowly. Government can do more, of course. One new initiative calls for local leaders to be dismissed whenever high numbers of girls drop out of school.

The logic is compelling: if girls remain in school, they can avoid "the cut" and early marriage. Once educated, these girls may decide for themselves - as I did - to resist mistreatment at the hands of their family and neighbors.

At the same time, much more needs to be done to combat the practice, in Kenya and everywhere in Africa where it continues. International opposition helps. For decades, activists in the United States and Europe have brought attention to the problem and urged African governments to prosecute perpetrators.

Nevertheless, because female genital mutilation is tied to a wider set of traditional practices involving the control of girl's bodies and minds, and because these traditions have a powerful hold on some Africans, ultimately the practice can be halted only through concerted efforts by Africans themselves. Only if we change the views of our friends and neighbors can more girls escape "the cut" - and never long for it.

Juliet Torome is a staff writer and photographer at The Nairobi Star, a daily newspaper in Kenya.

Doc tells of circumcision trauma

A Port Elizabeth doctor has spoken out about her years of traumatic experience of treating botched circumcisions. Dr Mamisa Chabula-Nxiweni was speaking as a panelist during the Dispatch Dialogues at Hudson Park High School in East London on Tuesday night.

They were asked to debate whether traditional circumcision was still relevant in the 21st century. [This assumes that it ever has been relevant.]

Burns-Ncamashe defended the old-age rite of passage to manhood, arguing that the misfortunes that have fallen the tradition should not be used as a measure to dismiss its relevance.

But Chabula-Nxiweni shocked the hall when she gave a personal account of seeing scores of initiates experiencing complications, which sometimes led to many of them losing their manhood.

The 61-year old mother of five men, who themselves went through the tradition, said in the past she had had to secretly treat initiates that experienced complications in Motherwell.

"These raised the alarm to me about what was going on. I have experienced so much trauma. Traditional circumcision has been embedded with complications and deaths which kill the original intention of making boys men," said Chabula-Mxiweni.

She recounted how in one incident at a provincial hospital an initiate had his private parts removed because of gangrene.

"He asked me what purpose would it serve if he continued living. I did not know what to tell him because that was his manhood being taken away. I just said God has a plan," she said.

Chabula-Mxiweni, whose personal accounts stirred many responses on how the tradition could be made safer, also related how a married man who had been amputated during circumcision earlier in his life went through a painful divorce because of the incident.

She constantly mentioned elders in Motherwell involved in circumcision who have managed to turn around the situation and that their knowledge should be utilised in the province.

Burns-Ncamashe argued that the deaths during traditional circumcision should not be a determining factor to end the custom.

He said the departure from indigenous wisdom has led to the norms and values of African society being distorted leading to reckless practices. [What makes cutting the most sensitive part of the penis off a "norm" or "value" of African society?]

Uganda: Community bans female circumcision

- By Bonny Apunyu

(SomaliNet) A local Ugandan official said on Wednesday that a community in eastern Uganda that has practiced female genital mutilation "since time immemorial" has banned the ritual.

Chairperson of Kapchorwa district Nelson Chelimo said: "The community decided that it was not useful, that women were not getting anything out of it, so the district council decided to establish an ordinance banning it"

Chelimo said that historically people in Kapchorwa believed that a woman who married without first being circumcised would be stricken for life with various illnesses, but that "those beliefs are really outmoded."

The district official said the campaign to end the practice has been alive in his community for several years, and that in the recent past, educated young women in Kapchorwa have shunned it.

The district council's ordinance will now be submitted to parliament so that it can become law, and subject to enforcement by the national police force.

The United Nations in 2007 passed a resolution that called female genital mutilation a violation of the rights of women and said it constituted "irreparable, irreversible abuse."

The resolution also said the practice increases the risk of HIV transmission [when performed under unhygienic conditions, as does male genital cutting - but at least one study suggests it reduces the risk of sexual transmission], as well as maternal and infant mortality. The UN estimates that between 100-million to 140-million worldwide have undergone the practice.-AFP

Matters of manhood

The intiation ceremoney is not merely about circumcision, writes Mthetho Tshemese

ON THE weekend of September 6, Fikile Mbalula, former president of the African National Congress Youth League (ANCYL), was circumcised under controversial circumstances in Phillipi, Cape Town.

Newspaper reports suggested that Mbalula was not aware that he was going to be circumcised and that ANC national executive committee members, Nyami Booi and Tony Yengeni, together with ANC Western Cape provincial secretary Mcebisi Skwatsha, orchestrated the process. [i.e. They ambushed, hijacked, kidnapped and mutilated him.]

One newspaper identified Mbalula’s traditional surgeon as 73-year-old Maduna Nqabeni from Gugulethu. The paper quoted Nqabeni saying: “Laa ntwana (that boy) was not informed about the circumcision. But now he has accepted what has happened. He is going to graduate and become a man and is looking forward to that.”

Mbalula’s going to the bush got tongues wagging, including my own. We were shocked that he had not been to initiation school.

Considering that Mbalula got married a couple of years ago, one finds it difficult to believe Mbalula family spokesperson Goodenough Kodwa’s assertion that Mbalula wanted to go for initiation four years ago.

If anything, it would seem that Mbalula did not particularly embrace the notion of traditional male circumcision and initiation into manhood.

Interestingly, his older brother, Jabu, formerly chairperson of the National Youth Commission, is also reported not to have undergone initiation.

Following news of Mbalula’s circumcision I had a discussion with friends who had gone through the initiation process. I asked if indeed traditional male circumcision and the initiation of boys into manhood, as it is currently practised, adds any value to the development of healthy masculine identities in those who undergo the process.

I also asked if traditional male circumcision, in its current form, is of any relevance to the needs of our society. While the discussion was vibrant and interesting, it was marked by intolerance and irritation at my even asking these questions. [Yes, that is a typical response to any questioning of circumcision for any of the myriad reasons given for doing it.]

Some felt that such questions should not be asked. One friend told me off, saying:

“You should know better. Having gone through the process yourself, you know this is our culture. Why must people question our traditions and who we are, yet no one questions others about what they do?” [But they should, and do.]

By asking these questions my friends felt I was “betraying” our culture. I was also being “othered” – deemed to be like those outsiders who questioned and criticised our traditions.

Those who are pro the ritual almost always advance this argument, which is based on the view that those who have not personally gone through ritual should not be talking about it.

But silencing and labelling people is not going to solve the problems we face. I still believe that there is a need to critically engage on the subject.

In the past decade, botched circumcisions that have lead to hospitalisation, amputations, and an escalating death toll have tarnished the reputation of the ritual.

Delinquent behaviour by initiates at initiation schools has raised serious questions about what young boys get taught at the schools.

Two examples come to mind. In one an Eastern Cape initiate was arrested on a rape charge and had to appear in court before the ritual was completed. In the second, stolen items, including television sets and other electric appliances, were found inside an initiate’s hut.

The upshot of all these factors have been calls from certain quarters for the ritual to be abolished, with some labelling it as barbaric, backward, and unconstitutional.

Ironically Mbalula’s case – if he was indeed abducted and forced to go to the bush – may well raise questions on an issue of constitutionality.

But most of the negative publicity and the criticism centres around the circumcision aspect. Some people have wrongly reduced the entire initiation process to being only about circumcision.

To my understanding the initiation of boys into manhood is a process which involves, yet is much bigger, than circumcision. It is a process that aims to teach the young initiates about respect for self and others, their family responsibilities, community leadership, and about carrying their family names with integrity.

The outcomes are largely dependent on the initiate’s support structure.

That we see a lot of initiates and “new men” behaving in ways that are not consistent with what Xhosa culture (broadly speaking) expects of men, tells us that it is fallacious to think that going to the bush automatically translates into maturity.

Perhaps the question that should be asked is: Are the good, responsible and respectful Xhosa men that we have in our society like they are because they went through traditional male circumcision and initiation? Or even more generally: Are the kind of Xhosa men we have in society a reflection of what is taught during the initiation process?

In other words, when trying to understand the Xhosa masculine identity with all its complexities, fluidity and the consequent behaviours associated with it, how much can be attributed to what initiates are taught during the initiation process?

And the dreaded question – is traditional male circumcision and the initiation of boys into manhood still relevant today?

These are very tough questions which don’t have simple answers.

I am in no way suggesting that traditional male circumcision and the initiation process is unimportant. If anything I am arguing that given its importance to those who practise it, we should be trying to critically look at whether the manner in which it is being practised today is achieving that which it is designed to do.

Traditional male circumcision and the initiation of boys into manhood is an ancient cultural ritual still practised by many worldwide.

In South Africa amaXhosa, like the amaNdebele, baPedi and vhaVenda are among those practising the ritual.

While it is widely practised and accepted as the punctuation of one’s identity and status as a man, it should not be seen as a once-off event, but rather a process that is matched by actions that symbolise, in Xhosa culture, maturity and growth from a child to an adult.

It has also changed with time to suite different contexts and practical demands. For instance, in the Eastern Cape the ritual used to take place in winter, but we have seen the summer holidays becoming a very busy season for initiates .

The desired outcome of the entire process, one could argue, is psychological rebirth. It demands renouncing old, childish, irresponsible – boyish behaviour if you will – thinking and behaviour and embracing maturity and responsibility to become well-adjusted citizens.

To give a glimpse of how this psychological rebirth is conceptualised, framed, and articulated, one can look at how people responded to Mbalula’s initiation. As the news of his going to the bush surfaced people started linking his usually abrasive and sometimes reckless comments and actions, as the then ANCYL president, to the fact that he had not been to initiation school.

One commentator remarked: “Now we understand why he acted in the manner in which he did. It should be expected that a boy acts disrespectfully from time to time because he is a boy and is just being himself. Now that he is a man he will behave differently because of what he will learn from the bush.” It is clear that this particular commentator assumes that every initiate will be changed by the process and the learning in the bush, with the clear and undisputable results being a more respectful and mature man.

But the commentator’s remarks oversimplify the matter somewhat. The fact that Mbalula’s older brother, Jabu, is said never to have undergone initiation himself, yet has a calmer, more well-measured way of dealing with political issues, challenges his view.

It remains to be seen whether Fikile’s political tact and public commentary will change now that he has been to the bush. And should they do so and he becomes less confrontational, would it be correct to simply attribute this to him having gone to the bush?

I hold the view that traditional rituals, including male circumcision and initiation of boys into manhood, do play a meaningful role in the development and enhancement of those who practise them. However, sentiment should not be the dominant consideration for people to practise these rituals. Instead their relevance should be based on the desired positive contribution that the rituals are set out to achieve.

When there are serious problems with the rituals, as we have seen with traditional male circumcision, all those involved have a duty to demonstrate that the positive contribution to people’s lives outweighs any harm caused by practising the ritual.

In a country where social ills such as violent crime, violence against women and children, alcohol and drug abuse, absentee fathers, and HIV/Aids are rampant – any initiative aimed at making better men is welcome.

The question then, that those who are pro-traditional male circumcision should ask themselves, is whether the ritual contributes meaningfully to making better men? And more pointedly, is the ritual responsive to the challenges we face in today’s society?

# Mthetho Tshemese is a clinical psychologist who grew up in Mdantsane and is now based in Johannesburg

'Circumcision to prevent HIV' is giving people false information

Jennifer Bakyawa

There is research suggesting that circumcising men help reduce the chances to contract HIV. Dr. Francis Mwesigye Runumi, the acting Director of Health Policy Planning and Management in the Ministry of Health talked to Jennifer Bakyawa about the relevance of the medical male circumcision research results

In December 2006, the Rakai Health Sciences Programme released results of a clinical trial on medical male circumcision. Were these results relevant in terms of policy for Uganda?We didn’t even know that this study was going on. Several research institutions partner with funders and conduct research. Much research is going on but we don’t know exactly how it was initiated. This is one of the researches that was conducted without much of our knowledge. However, when it came out, we discovered that some people amongst us had been informed. We began digesting the results the way they were released in the media; to find out if they had any implications in HIV/Aids control.

We were highly interested given that our main task is to find several practical interventions that can curb the HIV/Aids pandemic. But here was someone claiming to have conducted a study in Rakai on male circumcision and found it to have protective chances. We wanted more details given that we didn’t discuss the proposal; didn’t know the methodology; how the results had been collected and analysed; and the confidence levels that led them to adduce their claims.

There was a social debate on how Aids has been killing Muslims who were circumcised. How come researchers went to a community and found circumcision to be a preventive measure. If it is preventive in any way, we would have seen Muslims dying less than other religions and tribes that don’t circumcise. The researchers were appealing to the Ministry to pursue this as one of the prevention policies.

Reactions were mixed: some people thought it was preventive. A strong side said the study was irrelevant because people have circumcised, still contracted the disease and died. Telling the whole population to circumcise is giving them false information. They would get multiple sexual partners and may die like any other Muslim and tribes that circumcise for religious and cultural practices have been dying. We wanted more information before the Ministry took it up as one of the prevention strategies.

What did the Ministry do when the results were released?The Director General quickly raised the researchers at the Makerere University School of Public Health. They discussed the results with him. In his feedback to the Ministry’s management committee he said he had looked at the results and was convinced that there is room for prevention using this strategy of male circumcision.

Still, questions came up: How many people have been circumcised for a long time but still die? That is when we went a little deeper to understand the possibility of not contracting the disease can be enhanced by being circumcised. Still, there are some doubts. When we look at the cohort of circumcised people that died, there isn’t much difference with the one Rakai is claiming.

You said the researchers released the results in the media. Could they have approached this issue of releasing the results differently?The researchers knew their target audience. But as a Ministry, we felt that we should have had a presentation so that researchers discuss with us our concerns in order for us to understand better.

With time, this picture was corrected. This was something very big. Even when the President (Museveni) heard about it, he wondered if this is something we should push forward. He demanded for an explanation that would convince people that this is a real strategy for recommendation. The President has been an activist in Aids prevention. This was going to interfere with his ABC drive.

Releasing results to the media excited debate about the research but questions were coming to us, yet we had not exchanged views with researchers.

You said that the Director General of Health Services (Dr. Sam Zaramba) invited the researchers to brief him about the study results. What ordinarily would be the ideal approach for communicating research findings?Many researchers are doing very good work in their institutions. Whenever good results come out and have policy implications, the first thing researchers should do is to approach a policy maker and show them what they have found. Then the policy maker would share with his colleagues to get their opinion. This way, consensus is built right from the start. Good work from researchers may be a small fraction of a bigger picture, which would need to be completed first.

As policy makers, we could advise the researchers to investigate something else based on their results so that everyone sees the final picture. It could lead to a strong policy that would solve some pertinent problems the country is grappling with. When researchers get results they should endeavour to look for people who move things and are likely to use the results. They should discuss the results with them before sharing them with the broad community through the media.
...

Circumcision and the wedding

... The Minister of Health here in Kenya (one of 40 ministers by the way) has recently encouraged men to go for ‘the cut’ to reduce the risks of HIV/AIDS. We have not been able to verify this claim yet, but health clinics all over Kenya are now overcrowded with young men wanting to undergo the operation. In some remote villages, young men in groups go around looking for uncircumcised men and if they manage to find one, they carry out the operation themselves ...

Circumcision of Muslim boy not a crime - Finland's Supreme Court

A circumcision performed on a Muslim boy in Finland was not a penal offence, Finland's Supreme Court (KKO) decided Friday in a precedent setting case.

The Supreme Court decision concerned a Muslim mother who was charged with assault or incitement to assault for asking a doctor to circumcise her four-year-old son.

Previously the Tampere district court had ruled that the incident constituted assault, but did not issue a sentence for the mother.

The Turku intermediary court ruled that the mother's conduct did not constitute a penal offence.

However, according to the Supreme Court a circumcision done for religious reasons helped the son in the development of his identity. [This is a bizarre ruling: what does it mean?] The operation also helped him to become attached to his religious and social community. [So is this. He's four. How do they know if he will ever want to "become attached to his religious and social community"?]

The court decided that the child's parent was allowed to decide on the operation as it was not against the interests of the child. The boy's bodily integrity was violated only a little and as the operation was conducted under local anaesthetic, it did not cause the child unnecessary suffering.

Circumcision of boys in Finland - a questionnaire to Finnish paediatric surgeons

We sent a questionare to surgeons treating children’s phimosis and performing circumcision in Finland. We received responses from 90% of the hospitals, including 39 surgeons. 74% of the responders were paediatric surgeons and 18% were resident paediatric surgeons. They came from all parts of Finland so that the whole country was well covered.

The incidence of operative treatment of phimosis has declined during the last ten years in Finland. The most common operation for adolescent balanitis xerotica obliterans is still circumcision. Preputial plasty is the most widely used method for prepubertal boys. Physiological phimosis is seldom an indication for operative treatment in patients under age of 5 years. Topical steroids are widely used in first line treatment of phimosis. The operation is selected on the basis of discussions with patients and parents. All operations are performed under general anesthesia.

Non-medical circumcision is not performed in Finland except in a few hospitals. The most important reason for not performing cultural circumcision is that the total usefulness of the operation is questionable and that it does not benefit the boy’s health. Circumcision does not belong to Finnish culture. The condition for performing a cultural circumcision is the informed consent of the boy himself. Over one third of the responders accept cultural circumcision only if it is performed by medical professionals, under general anaesthesia, and the costs are paid by the boy’s parents. One third of the respondents, however, demanded criminalization of cultural circumcision of boys.

New Study Shows Condoms 95 Times More Cost-Effective than Circumcision in HIV Battle

Results of a new study, “The Cost to Circumcise Africa,” published in the International Journal of Men’s Health, that compares the cost of male circumcision to the cost of lifetime distribution of free condoms in sub-Saharan Africa, found that condom distribution is 95 times more cost-effective in preventing the same number of infections.

“Some might call circumcision an ‘HIV vaccine,’ but its moderate, supposed-effectiveness, along with its very high cost and practical dangers, makes it a questionable and risky preventative,” said co-author Ryan McAllister, PhD, Biophysics, Georgetown University, Washington, DC. “Condoms succeed 99% of the time, while circumcision, at best, fails about half the time.”

“Male circumcision is too costly to justify in the HIV battle. Even if circumcision does offer some protection against heterosexually transmitted HIV, condoms clearly provide much more protection, at a much lower cost,” said study co-author and Wellness Associates founder, John Travis, MD, MPH. “It just doesn’t make sense to perform mass surgeries in a region of the world struggling to meet the most basic healthcare needs, especially when there are more cost-effective plans for achieving the same results.”

The study’s findings suggest that behavior change programs are more efficient and cost-effective than surgical procedures. In addition, condom usage provides protection for women as well as men. This is significant in an area where almost 61% of adults living with AIDS are women.

Elder says he never backed cut

The chairman of the Luo Council of Elders, Ker Riaga Ogallo says that he was arm-twisted to endorse the male cut among the Luo community.

Ker Ogallo said that the whole affair had been turned into a cash cow by individuals and NGOs bent on enriching themselves.

He claimed that an NGO recently bought a fleet of vehicles and hired a few staff but did not have any structures.

“Our people are still languishing in poverty. No NGO is ready to offer practical assistance.

I am shocked that when it comes to circumcision of Luo youths, an organisation can import 24 new vehicles at once,” he said.

Ker Ogallo was reacting to accusations by elders from Homa Bay District that he had allowed “young politicians to turn our community into a laughing stock”.

Ker Ogallo assured the elders that at no time will he support the male cut, saying the choice was an individual’s.

“I want to tell you that I have weathered a lot of storms and arm-twisting to endorse male circumcision among our people.

I have however stood firm and will not accept it,” he said.

October 12, 2008

West African first ladies to join fight against female circumcision

OUAGADOUGOU (AFP) - First ladies from seven west African countries gather here Monday for a conference on ways to end female circumcision, a widespread practise in the region despite efforts to end it.

The three-day meeting will "discuss transboundary practices of circumcision in the region to better fight against the scourge," presidential spokesman Saidou Ouedraogo said.

First ladies from the west African countries of Benin, Ivory Coast, Ghana, Mali, Niger, Togo and Burkina Faso are due to participate, he said.

Female circumcision, or female genital mutilation (FGM), is common in some 30 African countries despite major awareness-raising campaigns and ever-tougher laws against the practise.

Burkina Faso is a case in point. Nearly half the country's women are circumcised according to a national committee on the issue.

The tradition continues despite new legislation stipulating prison sentences against FGM practitioners and their accomplices.

Uganda: Circumcision gone wrong

David Mafabi

When the blowing of horns and playing of kadodi started in January through May to August announcing the arrival of the ritual of circumcision amongst the Bamasaba, Rogers Wareba, like many other boys, declared his intentions to be circumcised. He never imagined that getting circumcised would cause serious health consequences by damaging his urethra to the point of having to use a catheter to pass urine.

"I was set for Imbalu this year to initiate me into manhood, so the talk about the knife was not an issue. What I wanted was to get circumcised traditionally and not shame my parents and ancestors or be declared a misfit in society," Wareba recalls.

He says that during the ordeal, he felt unusual pain in the urethra and bled but that traditionalists told him that he would heal with traditional care using herbs like it is done amongst all Bamasaba. "But after sometime, there was no change and my parents opted for hospital when I failed to pass urine. The doctors then inserted the catheter.

It is very painful but I don't have a choice because I need to heal and pass urine normally," says Wareba. He is not the only victim though. Records by doctors at Mbale Regional and Bududa Referral hospitals have registered and treated many such cases.

Although the tradition of circumcision (Imbalu) has come a long way, it is still disturbing to think of how these boys brave the crude knife even when there are hospitals that carry out circumcision in more hygienic and modern conditions.

Wareba however says that traditionalists don't regard medically done circumcision highly, saying it is for cowards and social misfits and that once circumcised that way, one would never be a leader in the clan nor preside over clan meetings.

Although medical experts have long recognised that circumcision has health benefits, they condemn traditional circumcision especially amongst the Bamasaba as an easy way of contracting diseases like HIV/Aids and that it is partly responsible for urethral complications amongst boys. [Partly? What else is responsible?]

A surgeon at Mbale Regional Hospital, Dr Peter Wakalyembe says that on many occasions, the traditional surgeons use one unsterilised knife to circumcise many candidates besides not using of gloves and failure to wash hands that put the candidates at risk of not only septic wounds but also transmission of new infections.

"There are already three cases admitted at Mbale Regional Hospital due to this traditional careless crude circumcision. One of them has had his urethra destroyed and he can't urinate. There could be many others ignorantly rotting in the villages," said Dr Wakalyembe.

He said that although there are research findings that male circumcision can protect men from contracting HIV by about 60 per cent, use of unsterilised knives for circumcision exposes candidates to risks of wound contamination, infection and spread of HIV/Aids, adding that research done by Communication Partnership revealed that although actively involved in circumcising, about 80 per cent of the surgeons lack training in the basics of circumcision, hygiene and health risks involved in the crude practice which explains why many children like Wareba are suffering the consequences.

A senior consultant surgeon at Mbale Regional Hospital, Dr Jaffer Balyejjusa said whereas under medical circumcision which he has been doing for the last 16 years great emphasis is put on hygiene, treatment, management of bleeding and treatment of the wound, they are all lacking in traditional circumcision.

"Besides wound contamination, infection and spread of disease due to poor hygiene, traditional surgeons make many mistakes during circumcision which have left many boys bleeding, taking long to heal and getting deformed," he said.

The Ministry of Health is working with Makerere University School of Public Health and Health Communication Partnership and has already started education and sensitisation programmes in Bugisu through community meetings, debates and Signal Radio spots to address such problems.

A local radio station is putting emphasis on promoting safe medical male circumcision under good hygiene, but the traditionalists are yet to cooperate.

Male circumcision and its relationship to HIV infection in
South Africa: Results of a national survey in 2002

Objective. To investigate the nature of male circumcision and
its relationship to HIV infection.

Methods. Analysis of a sub-sample of 3 025 men aged 15 years
and older who participated in the first national populationbased
survey on HIV/AIDS in 2002. Chi-square tests and
Wilcoxon rank sum tests were used to identify factors
associated with circumcision and HIV status, followed by a
logistic regression model.

Results. One-third of the men (35.3%) were circumcised. The
factors strongly associated with circumcision were age >50,
black living in rural areas and speaking SePedi (71.2%) or
IsiXhosa (64.3%). The median age was significantly older
for blacks (18 years) compared with other racial groups (3.5
years), p <0.001. Among blacks, circumcisions were mainly
conducted outside hospital settings. In 40.5% of subjects,
circumcision took place after sexual debut; two-thirds of
the men circumcised after their 17th birthday were already
sexually active. HIV and circumcision were not associated
(12.3% HIV positive in the circumcised group v. 12% HIV
positive in the uncircumcised group). HIV was, however,
significantly lower in men circumcised before 12 years of
age (6.8%) than in those circumcised after 12 years of age
(13.5%, p=0.02). When restricted to sexually active men, the
difference that remained did not reach statistical significance
(8.9% v. 13.6%, p=0.08.). There was no effect when adjusted for
possible confounding.

Conclusion. Circumcision had no protective effect in the
prevention of HIV transmission. This is a concern, and has
implications for the possible adoption of the mass male
circumcision strategy both as a public health policy and an
HIV prevention strategy.

Third of FSU immigrants avoid circumcision

Almost a third of male immigrants from the former Soviet Union are uncircumcised, according to a survey by the Geocartography Institute commissioned by the Jerusalem AIDS Project.

The project encourages circumcision here and abroad to reduce the risk of AIDS/HIV transmission.

Of those who have undergone ritual circumcisions, 37.3 percent had the procedure here and 5% had it performed when they were over 50. One percent underwent circumcision while they were in the I[srael ]D[efence ]F[orces].

Fewer than half had a brit mila at the halachicly required age of eight days.

The survey also found that 2.2% of women who immigrated from the FSU "didn't know" whether their partner was circumcised, and 72.8% of female partners of uncircumcised new immigrants would prefer that they don't undergo ritual circumcision.

Since 1990, when the major wave of immigration from the FSU began, half a million adult males have made aliya [migrated to Israel].

The Jerusalem AIDS Project said Monday that some 80,000 adult immigrants from the FSU and Ethiopia had undergone circumcision with a local anesthetic in a surgical theater.

...

Oh admit it! It doesn't protect.

October 7, 2008

No proof circumcision cuts gay male HIV risk: study

By Will Dunham

WASHINGTON (Reuters) - There is not enough evidence to say circumcision protects men from getting the AIDS virus during sex with other men even as studies show it protects them when having sex with women, U.S. researchers said on Tuesday. [Look how they rush to undo the story and defend circumcision, without even the courtesy of a comma to give us breath. 37 words is long for an opening sentence.]

A review of 15 studies involving 53,567 gay and bisexual men in the United States, Britain, Canada, Australia, India, Taiwan, Peru and the Netherlands failed to show a clear benefit for those who were circumcised, researchers from the U.S. government's Centers for Disease Control and Prevention said.

Circumcised men were 14 percent less likely to be infected with the human immunodeficiency virus, or HIV, than those who were uncircumcised, but the finding was not statistically significant, the CDC researchers said.

This story has been widely reported, emphasising the "protective effect" for heterosexuals, and sometimes leaving off the "not statistically significant" but presenting "14 percent" as if it were a measure of actual protection for men who have sex with men. Circumcision gets another free ride.

"You can't necessarily say with confidence that we're seeing a true effect there," said the CDC's Gregorio Millett, who led the study that appeared in the Journal of the American Medical Association.

"Overall, we're not finding a protective effect associated with circumcision for gay and bisexual men," Millett said in a telephone interview.

Studies involving men in Africa, where the AIDS epidemic is primarily spread by sex between men and women [with multiple, concurrent partners], showed that male circumcision halved the risk of female-to-male HIV infection.

Experts say this reduced HIV risk may be because cells on the inside of the foreskin, the part of the penis cut off in circumcision, are especially susceptible to HIV infection. [Or because the studies were faulty and conducted by circumcision enthusiasts.] The virus also may survive better in a warm, wet environment like that found beneath the foreskin [or inside the vagina].

But whether circumcision might lower the risk of HIV infection in sex between men had remained unclear. Gay and bisexual men play a much larger role in AIDS in many countries outside of Africa, the epidemic's epicenter.

NOT RECOMMENDED

For example, the CDC last week said 48 percent of the 1.1 million Americans infected with HIV are men who have sex with men. More than three-quarters of U.S. men are circumcised.

"We really cannot recommend overall male circumcision as a strategy for men who have sex with men in the United States," Millett said.

The CDC's Dr. Peter Kilmarx, who was not involved in the research, said the agency is preparing formal recommendations on circumcision in the United States, with a draft due to be made public early next year.

Millett said there are signs circumcision might protect certain gay and bisexual men depending on sexual practices.

The virus can be transmitted through blood or semen.

Studies in Australia and Peru showed that men who engaged in insertive anal sex only and were not being penetrated by male sex partners got a significant protective effect from HIV infection from being circumcised, Millett said. [The Australian study involved seveninsertive men - and how many circumcised men are there in Peru?]

"Of course, if you're being penetrated by a partner during sex, you being circumcised is not going to protect you from HIV infection," Millett said. [But him being circumcised might put you at greater risk. They didn't measure that.]

Millett said two U.S. studies and one in Peru conducted before the introduction in 1996 of combination drug treatment for HIV infections, called highly active antiretroviral therapy, or HAART, showed that circumcised men were 53 percent less likely to be infected with HIV than uncircumcised men.

Supreme court turns away Oregon circumcision case

The US Supreme Court has declined to hear the Boldt vs. Boldt case in
Oregon confirming the Oregon Supreme Court's decision that the boy has a
right to have a say about his penis and whether he is circumcised or not.

by Ashbel S. Green,

The U.S. Supreme Court today
declined to take up an Oregon dispute between a father who wants to
circumcise his 13-year-old son against the wishes of the boy's mother.

The case now goes back to an Oregon trial judge to determine whether the
boy wants to undergo the procedure.

James Boldt, a former Southern Oregon resident who converted to Judaism,
says his son wants to be circumcised for religious reasons.

Lia Boldt claims her son is afraid to tell his father that he does not
want to undergo the procedure.

The Boldts married in the early 1990s. She filed for divorce in 1998.

The boy initially lived with his mother, but the father later gained
custody. James Boldt started studying Judaism in 1999 and eventually
converted.

James Boldt claims that as the custodial parent he has a constitutional
right to raise his son in his religion.

The Oregon Supreme Court earlier this year did not rule on the substance
of the dispute, but said the trial judge needed to determine the boy's
wishes before deciding which parent to side with.

University Law Institute to review circumcision law

MALE CIRCUMCISION

The project will review the current law regulating the circumcision of male children in Australia, with particular reference to Tasmania. The project will examine the criminal and civil responsibility of those who perform, aid or instigate the procedure.

In relation to civil responsibility, the project will examine the requirement of informed consent and the unique nature of the procedure (e.g. that it is most commonly performed on neonates; that it is rarely medically necessary; and that it is sometimes performed outside of a surgical setting by people without medical qualifications who vary on the degree of their recognition of the various recommended surgical techniques).

Questions of who may consent or authorise the procedure when children are involved will also be addressed. This will include a discussion of the Family Law Act and the common law upon the question of whether, and if so when, the authorisation of the courts may be required for the procedure. The role of the Child’s consent or otherwise to the procedure will also be discussed in light of ‘Gillick’s Case’ [1985] 3 All ER 402 and recent High Court decisions.

The possible constitutional, equal protection from the law and discrimination issues that arise depending on whether circumcision is lawful or unlawful currently will also be investigated.

In examining these issues, the project will take account of the law in foreign jurisdictions and international law.

This topic for law reform was suggested by the Tasmanian Commissioner for Children.

An issues paper will be released in 2008.
If you would like to receive a copy of the Issues paper, please contact the Institute.